18FDG positron emission tomography mining for metabolic imaging biomarkers of radiation-induced xerostomia in patients with oropharyngeal cancer

Hesham Elhalawani, Carlos E. Cardenas, Stefania Volpe, Souptik Barua, Sonja Stieb, Calvin B. Rock, Timothy Lin, Pei Yang, Haijun Wu, Jhankruti Zaveri, Baher Elgohari, Lamiaa E. Abdallah, Amit Jethanandani, Abdallah S.R. Mohamed, Laurence E. Court, Katherine A. Hutcheson, G. Brandon Gunn, David I. Rosenthal, Steven J. Frank, Adam S. GardenArvind Rao, Clifton D. Fuller

Research output: Contribution to journalArticlepeer-review


Purpose: Head and neck cancers radiotherapy (RT) is associated with inevitable injury to parotid glands and subsequent xerostomia. We investigated the utility of SUV derived from 18FDG-PET to develop metabolic imaging biomarkers (MIBs) of RT-related parotid injury. Methods: Data for oropharyngeal cancer (OPC) patients treated with RT at our institution between 2005 and 2015 with available planning computed tomography (CT), dose grid, pre- & first post-RT 18FDG-PET-CT scans, and physician-reported xerostomia assessment at 3–6 months post-RT (Xero 3–6 ms) per CTCAE, was retrieved, following an IRB approval. A CT-CT deformable image co-registration followed by voxel-by-voxel resampling of pre & post-RT 18FDG activity and dose grid were performed. Ipsilateral (Ipsi) and contralateral (contra) parotid glands were sub-segmented based on the received dose in 5 Gy increments, i.e. 0–5 Gy, 5–10 Gy sub-volumes, etc. Median and dose-weighted SUV were extracted from whole parotid volumes and sub-volumes on pre- & post-RT PET scans, using in-house code that runs on MATLAB. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test differences pre- and post-RT. Results: 432 parotid glands, belonging to 108 OPC patients treated with RT, were sub-segmented & analyzed. Xero 3–6 ms was reported as: non-severe (78.7%) and severe (21.3%). SUV- median values were significantly reduced post-RT, irrespective of laterality (p = 0.02). A similar pattern was observed in parotid sub-volumes, especially ipsi parotid gland sub-volumes receiving doses 10–50 Gy (p < 0.05). Kruskal-Wallis test showed a significantly higher mean RT dose in the contra parotid in the patients with more severe Xero 3-6mo (p = 0.03). Multiple logistic regression showed a combined clinical-dosimetric-metabolic imaging model could predict the severity of Xero 3-6mo; AUC = 0.78 (95%CI: 0.66–0.85; p < 0.0001). Conclusion: We sought to quantify pre- and post-RT 18FDG-PET metrics of parotid glands in patients with OPC. Temporal dynamics of PET-derived metrics can potentially serve as MIBs of RT-related xerostomia in concert with clinical and dosimetric variables.

Original languageEnglish (US)
Pages (from-to)93-101
Number of pages9
JournalClinical and Translational Radiation Oncology
StatePublished - Jul 2021


  • Head and neck cancer
  • Imaging biomarkers
  • Predictive model
  • Radiotherapy
  • Xerostomia

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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